OPEN OR CLOSED ICU?

Intensive Care Units (ICUs) can have an “open” or “closed” arrangement. “Open” means the physician responsible for the patient admits the patient to the ICU and keeps the formal responsibility for the patient and his treatment. The intensivist is a consultant without primary responsibility for the patient. A “closed” format means the patient is admitted to the ICU and the responsibility for the patient and his treatment is transferred to the intensivist.

This study in BMC Surgery leans towards closed units offering the better care. The study points out that the intensivist is specialised in caring for critically ill patients and dedicates his whole time to that. Of course, other doctors, including the doctor caring for the patient until the ICU transfer, are consulted as needed. This study was a cohort study looking at one Dutch ICU that changed from open to closed at the turn of the millenium. So they used cohorts from 1996-1998 for the open format and 2003-2005 for the closed format. There was a mortality reduction from 25.7% to 15.8% between the cohorts. Of course, there’s also a time difference and lots of other confounders, but such a huge mortality benefit is likely to partly have been impacted by the transfer of care over to the intensivists. This was also supported by comparing the numbers to Dutch nation wide ICU mortality trends over the same time spans.

Due to all the limitations inherit in such a study, this is far from the perfect study or the final word in open vs closed ICUs, but it’s an interesting article on the concepts and food for thought on how best to organise our ICUs.

Full article:
The impact of open versus closed format ICU admission practices on the outcome of high risk surgical patients: a cohort analysis, BMC Surg, 2011.

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